150,000 may lose Oregon Health Plan medical insurance by July 1
Oregon state legislators are considering killing the Oregon Health Plan, reducing it once more to just plain Medicaid, and taking away medical insurance from 150,000 Oregonians. Go to the website address below and tell them not to do this. ANYTHING else should be cut first -- prisons, schools, etc. Survival should be the highest priority for funding.
March 8, 2003
Shortfall has neediest facing 'bare-bones' health coverage
Legislators trying to retool the Oregon Health Plan have discovered that the budget crisis is far worse than they thought.
The state budget for the next two years has barely enough money to keep minimum doctor-and-hospital coverage for the 350,000 neediest Oregonians -- those who by federal law must be included.
Let alone prescription drugs or mental health care. Let alone addiction treatment. Let alone wheelchairs or diabetes test strips.
Preserving those benefits -- which are optional under federal law but deemed essential by health officials -- would leave the health plan $127 million in the hole.
"This is as bare-bones as you can get," said Rep. Ben Westlund, R-Bend, chairman of a new House committee taking the lead in redesigning the health plan. "We were all startled when we came up with that number."
And unless the health plan reduces its costs, it might have to drop another 150,000 Oregonians entirely.
The health plan is essentially Oregon's expanded version of the federal-state Medicaid program for low-income people. It covers two basic groups.
The first group includes about 350,000 low-income Oregonians who automatically qualify for Medicaid because they are blind, disabled, elderly, on welfare, in foster care or pregnant. The second includes 130,000 other adults with incomes below the poverty line, and 20,000 children.
In the scenario that legislators are working through, benefits would be trimmed for the first group and eliminated for the second.
"It would be a real U-turn for Oregon" to cut its coverage so drastically, said Barbara Lyons, deputy director of the Kaiser Commission on Medicaid and the Uninsured, which tracks state health programs.
"It is not good," Westlund told his fellow committee members this week. "In fact, it's horrible."
Although benefits such as prescription drugs are optional under federal Medicaid law, every state chooses to cover them for the neediest.
Restructuring the Oregon Health Plan has enormous implications for Oregonians -- and not just those on Medicaid. As the number of uninsured and underinsured rises, the added cost of their care will be paid by other residents in the form of higher taxes, insurance premiums and hospital bills.
Exactly what a budget-whacked health plan will look like on July 1, when the next budget cycle begins, depends on revenue estimates and legislative decisions in the next three months.
Westlund and Sen. Jackie Winters, R-Salem, organized a work group to come up with ways to bring the health plan into line with a shrinking budget.
The group -- whose meetings are closed to the public -- includes key legislators and representatives of the governor's office, the state Department of Human Services, doctors, hospitals, the drug industry and insurers.
"They have impossible choices to make," said Lynn Read, head of the Office of Medical Assistance Programs, which runs the health plan and provided the latest budget numbers to legislators.
Prescription issue Westlund has directed the work group to look for ways to trim health plan costs enough to restore prescription drug coverage -- at least -- for its neediest members.
During the next month, Westlund's committee will turn those proposals into a list of recommendations for the Joint Ways and Means Committee.
"If we are successful in this project, we will be successful only in providing a bare-bones benefit," said Rep. Alan Bates, D-Ashland. "There are a lot of pieces missing."
One missing piece is the more than 100,000 Oregonians added when the state expanded its Medicaid program nearly 10 years ago. These include mostly couples and single people in low-paying jobs that leave them below the poverty line of $18,400 for a family of four.
Those 100,000 won a reprieve this month when legislators and the governor scrambled to restore their prescription drug benefits for the next three months.
But they face the possible loss of all coverage -- even basic hospital and doctor care -- after July 1.
Because revenues are falling faster than expected, Gov. Ted Kulongoski's "balanced budget" issued in January is no longer in balance.
But dwindling revenues are not the only culprit. The governor's budget cut state funds for the health plan by 22 percent from the current level, but it assumed there would be no increase in cost or use of the plan. Those assumptions proved unrealistic because medical costs are rising sharply, and more Oregonians are losing insurance because of the recession.
"Obviously, the numbers aren't encouraging," said Erinn Kelley-Siel, Kulongoski's health policy adviser and a member of the health plan work group. "That doesn't mean we've given up entirely on the optional population, but we have some work to do before we get there."
Other challenges Besides the obvious shortage of money, health officials face other challenges. For example, when prescription drug coverage is cut, the overall cost of care goes up because patients have trouble controlling chronic illnesses such as high blood pressure and diabetes.
Another problem: Dismantling the Oregon Health Plan would require federal approval because it would violate the state's current agreement with the Medicaid program. Waiting for that approval could delay the cost-cutting changes.
"We knew this would be tough," Kelley-Siel said. "But the magnitude of how tough has gone beyond our original expectation."
Don Colburn: 503-294-5124; firstname.lastname@example.org
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